Education

Master of Arts (MA)
in Occupational Therapy
2015 | University of Southern California

Bachelor of Arts (BA)
in Psychology
2011 | University of California, Irvine

Research Interests

As a career scientist, I aspire to conduct translational research that informs interventions and strengthens the evidence-base for hand therapy practice. I am interested in exploring novel assessment and intervention methods that promote holistic treatment, as well as facilitate patient adherence and engagement in their own recovery to maximize occupational performance in daily life. My current work involves examining these concepts from both theoretical and applied perspectives. I am conducting a literature review on the concepts of adherence, as well as evaluating a set of qualitative data regarding the experience of patients who received mind-body interventions as part of their hand therapy. In addition to this work, I am actively involved in exploring the use of sonographic imaging as a technique for understanding musculoskeletal pathologies in the upper extremities. Specifically, I am supporting research in the lab that uses imaging to evaluate the impact of occupational performance on changes in the median nerve. As part of this study, we are also conducting a meta-analysis that will identify reference values for the typical size of the median nerve in healthy subjects using musculoskeletal sonography. As I move forward into my own independent work, I hope to apply these concepts (i.e., adherence/engagement, musculoskeletal sonography, occupational performance) in evaluating hand therapy assessment and rehabilitation techniques. My current focus is using these concepts to enhance patient recovery and return to meaningful occupations following tendon injury and repair.

Background. Median nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values.

Methods. Articles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles.

Discussion. A comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology.

Musculoskeletal sonography is being widely used for evaluation of structures within the carpal tunnel. While some anatomical variants, such as bifurcated median nerves and persistent median arteries, have been well documented, limited literature describes the sonographic appearance of aberrant muscle bellies within the carpal tunnel. Multiple examples of the sonographic appearance of flexor digitorum superficialis and lumbrical muscle bellies extending into the carpal tunnel are provided. Techniques for static image acquisition and analysis are discussed, and the use of dynamic imaging to confirm which specific muscle belly is involved is described. Knowledge of the potential presence of muscle bellies in these images and ability to identify these structures is vital to avoid misclassification or misdiagnosis as abnormal pathology. The case examples are situated among current published evidence regarding how such anomalies may be related to the development of pathologies, such as carpal tunnel syndrome.

This study explored the experiences of eight patients with upper extremity disorders who participated in mind–body interventions in outpatient rehabilitation. Using a qualitative descriptive method, four themes emerged, alluding to multiple benefits of holistic practice.

This mapping review describes the scope of literature published over 10 years on the rehabilitation of upper extremity musculoskeletal disorders. Cross comparisons of diagnoses, interventions, and outcomes illuminate priorities for future work (e.g., occupation-based interventions and outcomes).

Introduction. Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice.

Purpose of the Study. The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research.

Methods. A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice.

Results. Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status.

Discussion. Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions.

Conclusions. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes.

Affective processing, known to influence attention, motivation, and emotional regulation is poorly understood in young children, especially for those with neurodevelopmental disorders characterized by language impairments. Here we faithfully adapt a well-established animal paradigm used for affective processing, conditioned place preference (CPP) for use in typically developing children between the ages of 30-55 months. Children displayed a CPP, with an average 2.4 fold increase in time spent in the preferred room. Importantly, associative learning as assessed with CPP was not correlated with scores on the Mullen Scales of Early Learning (MSEL), indicating that CPP can be used with children with a wide range of cognitive skills.